水针刀治疗膝骨关节炎的临床观察

发布时间：2018-05-06 16:50

本文选题：水针刀疗法 + 针刀疗法　；参考：《中国中医科学院》2015年硕士论文

【摘要】：目的：膝骨关节炎(KOA Knee Osteoarthritis)是发生于膝关节的一种慢性、退行性骨关节疾病,是骨科临床的常见病。KOA的主要临床表现为疼痛、肿胀,并多伴虽有关节僵硬、变形及活动受限等表现,严重者导致关节功能障碍甚至残疾,严重影响患者的生存质量。对KOA的治疗目标主要集中在1、缓解疼痛2、改善功能3、延缓软骨退化避免或减少畸形。水针刀治疗KOA在临床上已得到一定应用,据文献报道取得了较好的临床疗效,可有效缓解疼痛并改善关节功能。水针刀疗法集针刺、注射和针刀疗法之优势,将药物与针刀结合在一起。既可起到活血疏筋,又有松解粘连改善应力不匀,并还可通过药物达到消炎等作用。中医治疗虽短期疗效较好,但由于缺乏临床统一的疗效评判标准,且临床报道缺少严谨的科研设计与统计学处理从而缺乏说服力。本研究通过使用水针刀治疗KOA,并观察VAS评分、Lequesne膝骨关节炎严重程度指数(ISOA index of severity for osteoarthritis of hip and knee)等相关指标,以探讨评价水针刀治疗膝骨关节炎的临床疗效研究方法：本试验为临床多中心试验,三所临床医院分别收录符合纳入标准患者30例,本试验共收录患者90例。各组患者皆由了解标准操作规程的主治及以上医师按统一方法进行治疗,每周两次,共治疗两周。分别于治疗开始第一天及治疗结束两天内记录VAS评分、ISOA指数(ISOA index of severity for osteoarthritis of hip and knee)两项观察指标。并根据患者的各项观测指标数据进行统计分析,评价水针刀治疗膝骨关节炎的临床疗效。采用excel 2003表录入数据,spss20.0软件对数据处理分析。计量资料采用均数±标准差进行统计描述,前后对比采用t检验进行比较,P值≤0.05被认为有统计学意义。结果：治疗前后相关指标比较：各组治疗后VAS疼痛评分及ISOA指数均显著下降,与治疗前相比,差异具有统计学意义(P0.05),表明患者于各临床试验中心经水针刀治疗后疗效显著。将三所临床试验中心数据统一分析后显示,本次试验治疗后VAS疼痛评分及ISOA指数均显著下降,差异具有统计学意义(P0.05)。表明本试验中患者经水针刀治疗后疗效显著。将ISOA指数拆分为日常生活疼痛、步行距离(步行能力)、日常活动能力三部分评分。见各组治疗后数据及本试验治疗后数据,三部分评分均显著下降。与治疗前相比,差异具有统计学意义(P0.05)。表明水针刀治疗在步行能力、日常活动能力、日常生活疼痛这三方面都有显著治疗作用。依据ISOA严重程度分级标准,将本试验患者分为中、重、很重、极重四组。见各严重程度分组治疗后评分均显著下降。与治疗前相比,差异具有统计学意义(P0.05)。根据疗效评价标准,包头组总有效率100%,广州组总有效率100%,温州组总有效率93%,本试验总有效率97%。本试验各临床试验中心患者均未见不良事件。结论：本研究结果表明,运用水针刀治疗KOA能显著缓解患者膝关节疼痛症状,一定程度上改善膝关节功能,其中包括步行能力的改善及日常活动功能的改善。是临床改善膝骨关节炎疼痛症状及功能的安全有效的方法。
[Abstract]:Objective: KOA Knee Osteoarthritis is a chronic and degenerative osteoarthrosis of the knee joint. The main clinical manifestation of the common clinical.KOA in the Department of orthopedics is pain, swelling, and many associated with joint stiffness, deformation and limited activity, serious joint dysfunction or even disability, serious impact on the joint. The quality of life of the patients. The target of KOA is mainly focused on 1, alleviating pain 2, improving the function 3, postponing the degeneration of cartilage or reducing malformation. The treatment of KOA with water needle knife has been applied in clinical practice. According to the literature, it has achieved good clinical effect, can effectively relieve pain and improve joint function. The advantages of injection and needle knife therapy combine drugs and needle scalpel together. It can not only play the blood circulation and sparsely tendons, but also have loose solution and adhesion to improve the stress unevenness, and can also achieve anti-inflammatory effects through the medicine. Although the short term effect of traditional Chinese medicine is good, it lacks the clinical unified curative effect evaluation standard, and the clinical report lacks rigorous scientific research design and unification. This study used water needle scalpel to treat KOA, and observed the VAS score, Lequesne knee osteoarthritis severity index (ISOA index of severity for osteoarthritis of hip and) and other related indexes, in order to evaluate the clinical efficacy of water needle knife in the treatment of knee osteoarthritis. A total of 30 patients were included in three clinical hospitals, and 90 patients were included in this test. All the patients were treated by the standard operating procedures and the above doctors were treated by a unified method, two times a week for two weeks. The VAS evaluation was recorded at the first day of treatment and the end of the treatment for two days respectively. The ISOA index (ISOA index of severity for osteoarthritis of hip and knee) was used to evaluate the clinical efficacy of the water needle knife in the treatment of knee osteoarthritis according to the data of the patients' observation index. The data were recorded by the Excel 2003 table, and the data were analyzed. The standard deviation was compared with the t test. The P value less than 0.05 was considered statistically significant. Results: the relative indexes before and after treatment were compared: the VAS pain score and the ISOA index decreased significantly after treatment, and the difference was statistically significant compared with that before treatment (P0.05), indicating that the patients were in the clinical trial center. After the treatment of three clinical trial centers, the VAS pain score and the ISOA index were significantly decreased after the treatment, and the difference was statistically significant (P0.05). The results showed that the patients were treated significantly with water Acupotomy. The ISOA index was divided into daily life pain and walking distance. Three parts of daily activity were scored. The scores of the three parts were significantly decreased after the data of each group after treatment and the data after the treatment. The difference was statistically significant compared with that before treatment (P0.05). It showed that water needle knife treatment had significant therapeutic effects on the walking ability, daily activity, and daily life pain. According to the ISOA severity grading standard, the test patients were divided into four groups, heavy, heavy and heavy. The scores of each group were significantly decreased after treatment. Compared with before treatment, the difference was statistically significant (P0.05). According to the evaluation standard of curative effect, the total effective rate of Baotou group was 100%, the total effective rate of Guangzhou group was 100%, and the total effective rate of Wenzhou group was 93%. The total efficiency of the test was 97%.. No adverse events were found in all clinical trial centers. Conclusion: the results of this study showed that the treatment of KOA with water Acupotomy could significantly alleviate the symptoms of knee joint pain in patients, and to some extent improve the function of the knee joint, including the improvement of walking ability and the improvement of daily activity function. It is the clinical improvement of the knee. Osteoarthritis pain symptoms and function of a safe and effective way.

【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R684.3

【参考文献】